CMS Opens Application Portal for Primary Care and Kidney Care Payment Models

November 4, 2019

The Centers for Medicare & Medicaid Services (CMS) Innovation Center last week released Requests for Applications for the Primary Care First and Kidney Care Choices (KCC) payment models. Both voluntary models build on previous CMS initiatives and are intended to improve the quality of care for their relevant populations while reducing overall costs. Applications for both models are due to CMS on January 22, 2020.

The Primary Care First model is for practices that are prepared to take on greater risk and possess advanced capabilities such as enhanced access, care management, and quality improvement. Applicants must be located in specific regions—including New York’s Buffalo region, the North Hudson-Capital region, New Jersey (statewide), and Rhode Island (statewide)—and must not be participants in the Comprehensive Primary Care Plus model. Increased payments will be available for participating providers to support care for patients with complex chronic needs and serious illnesses. The payment model will incorporate adjustments based on performance in measures of quality, hospital utilization, and patient experience. Primary Care First is a multi-payer initiative, and CMS is concurrently seeking interest from commercial payers.

The KCC model has two options that will test whether financial incentives can improve quality of care and reduce costs for people with stage 4 and 5 chronic kidney disease and end-stage renal disease. Both models include bonus payments to promote kidney transplants. The Kidney Care First model option is open to practices and their participating nephrologists who manage the target patient population. Participating practices will receive capitated payments for office visits and care management services with adjustments based on performance. The Comprehensive Kidney Care Contracting option requires nephrology practices to partner with transplant providers and/or organ procurement organizations, with optional participation of dialysis facilities to form a Kidney Contracting Entity (KCE). KCEs may select from three payment options with increasing levels of risk and opportunity for shared savings/shared losses.

GNYHA sent finance bulletins with additional details on each model. More information on the initiatives is available on CMS’ Primary Care First and KCC Model websites.